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Studies of inoperable NSCLC patients have previously shown a small but statistically significant advantage in median survival with combined modality treatment, ie: chemoradiation. This appears to hold true for both sequential and concurrent modality regimens. Data suggests that concurrent chemoradiation may be superior to induction chemotherapy followed by radiation, but at the possible costs of increased toxicity and logistical difficulty. This study aimed to determine whether induction chemotherapy followed by concurrent chemoradiation is superior to induction chemotherapy followed by radiation alone in pts with unresectable NSCLC.

Induction chemotherapy followed by concurrent chemoradiation appears to have an accepatble toxicity profile.

The toxicities are not statistically significantly different from induction chemotherapy followed by radiation alone.

A higher complete response rate and less progressive disease was seen in the chemo--> chemoRT group.

Time to progression was statistically significantly longer in chemo--> chemoRT group.

Survival analysis is not yet mature enough to show any statistically significant survival difference.

Clinical/Scientific Implications

Induction chemotherapy followed by concurrent chemoradiation may play a role in the treatment paradigm for unresectable NSCLC (stage IIIA/IIIB) patients. This regimen appears to be well tolerated in some patients compared to sequential chemotherapy and radiation. However, a significant number of patients were dropped from the study prior to randomization which can lead to significant bias. Because of this, an intent to treat analysis is not performed. Thus after induction chemotherapy, only the most fit patients who did not progress went on to randomization. This must be remembered when the data presented is considered. Futures studies are warranted to evaluate this regimen.

Dec 29, 2010 - The addition of gemtuzumab ozogamicin to induction chemotherapy among younger patients with acute myeloid leukemia appears to improve survival with little additional toxicity, according to a study published online Dec. 20 in the Journal of Clinical Oncology.